Barbotage for Calcific Tendonitis
A condition where hard calcium deposits form within the tendons of the rotator cuff
What is barbotage?
Barbotage (also known as percutaneous lavage or needling) is a minimally invasive procedure used to treat calcific tendonitis—a condition where hard calcium deposits form within the tendons of the rotator cuff, causing severe shoulder pain and limited movement.
Instead of surgery, this procedure uses a fine needle to break up the calcification and flush it out of the tendon, relieving pressure and pain.
The Procedure: Step-by-Step
Performed under high-resolution Ultrasound Guidance.
1. Patient Preparation & Visualization
The patient is seated or lying down comfortably. The radiologist or sports physician uses an ultrasound probe to locate the precise position and size of the calcium deposit. The skin is sterilised to prevent infections.
2. Local Anaesthesia
A local anaesthetic (such as lidocaine) is injected into the skin and the subacromial bursa (the fluid-filled sac above the tendon) to ensure the procedure is virtually painless.
3. Needle Placement
Using real-time ultrasound imaging, a needle is guided directly into the calcium deposit. The operator watches the screen to ensure the needle enters the calcification without damaging surrounding healthy tissue.
5. Lavage (The “Washing” Phase)
This is the core of the procedure.
- Fragmentation: The operator may gently poke the deposit to break up hard “chalk-like” calcium.
- Aspiration: Saline (sterile salt water) is pulsed in and out of the syringe. This turbulence loosens the calcium, which is then sucked back into the syringe. You may see a cloud of white, calcium-rich fluid entering the syringe (often described as looking like toothpaste or chalk dust).
5. Therapeutic Injection
Once the calcium is removed, the needle is withdrawn slightly into the bursa, and a corticosteroid (strong anti-inflammatory) is usually injected to prevent post-procedure inflammation and pain.
6. Post-procedure
A small plaster is applied. The arm may feel heavy due to anaesthetic, but this wears off in a few hours. Physiotherapy is usually recommended after a few days to restore a range of motion.
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